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Wisconsin rates for HCPCS 99214

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

Facilitymedian $166 · 10th–90th $78–$4470%5%10th90th$166Professionalmedian $132 · 10th–90th $71–$3390%5%10th90th$132$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $199.53 / $416.87
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$79.43 / $309.03 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $123.03 / $346.74
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $144.54 / $346.74
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$95.50 / $234.42 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $154.88 / $281.84
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $117.49 / $169.82
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $398.11 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $199.53 / $363.08
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $107.15 / $208.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $234.42 / $331.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $109.65 / $239.88
Medica
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$39.81 / $269.15 / $416.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $281.84 / $398.11
Medica
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$194.98 / $263.03 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $102.33
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $162.18 / $269.15
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $338.84
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $630.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $181.97 / $794.33
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $151.36
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $190.55 / $263.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $75.86 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $245.47 / $323.59
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $95.50 / $194.98